May 2020

Camille Cioffi, University of Oregonr

COVID-19: Perinatal Support

Providing necessary care and social support is critical during the perinatal time period to ensure the health and well-being of parents and children. Due to concerns related to COVID-19, hospitals have limited the number of people who can be present during and following birth. There are also fewer opportunities for face-to-face meetings at follow-up pediatrics and obstetrics appointments following birth. These structural changes are resulting in reduced social support and may result in higher maternal and infant mortality due to under-identification of perinatal complications.
PRENATAL
  • The American College of Obstetricians and Gynecologists (ACOG) recommends modifying or reducing prenatal visits during the COVID-19 crisis.
  • Among the general population, reducing the number of in-person visits and leveraging telehealth may reduce stress and does not adversely affect the mother or child.[1]
  • However, mothers at risk for negative pregnancy outcomes (e.g., mothers who use substances, smoke, or have a sexually transmitted infection) are generally less likely to receive adequate prenatal care and may be even less likely to receive care during the COVID-19 pandemic. The early identification of pregnancy among these mothers is important to reduce adverse birth outcomes.[2]
  • Alternative strategies should be used to identify pregnancy during COVID-19, especially for mothers with a higher likelihood of high-risk pregnancy. For instance, providing opportunities for screening at syringe exchange programs.
  • Pregnancy loss during COVID-19 may be particularly challenging for parents. When possible, partners should be allowed to be present during a miscarriage, similar to provisions for birthing, to reduce mothers’ psychological distress.[3] Telehealth referrals to mental health care providers should be provided to mothers closely following pregnancy loss.

BIRTH
  • Having a support person present during birth, such as partners and doulas, is associated with improved infant outcomes and decreased likelihood of maternal depression.[4]
  • The CDC recommends allowing one essential support person during birth when possible; however, some hospitals cannot allow any support persons due to the risk of transmitting COVID-19.[5] Medical professionals could benefit from receiving additional guidance on providing mothers social support during this time. Receiving postpartum care from a consistent care giver improves patient perceived support.[4]
  • ACOG recommends expediating hospital discharge and using telehealth for follow-up appointments after birth.[6] Physicians may need additional training to successfully use telehealth modalities.

EARLY POSTNATAL
  • Special attention should be focused on providing social and medical support to women in the postpartum period to prevent additional complications.
  • African American women [7] may be experiencing disproportionately heighted challenges due to COVID-19 and need additional support to promote their postnatal health and well-being. COVID-19 is disproportionately affecting African Americans [8] and African American women are already at greater risk for maternal mortality.[9]
  • Electronic screeners for mental health concerns and physical concerns could be leveraged prior to visits to ensure the appointment is thorough.[10]

References

 

  1. Butler Tobah YS, LeBlanc A, Branda ME, et al. Randomized comparison of a reduced-visit prenatal care model enhanced with remote monitoring. Am J Obstet Gynecol. 2019;221(6):638.e1-638.e8. doi:https://doi.org/10.1016/j.ajog.2019.06.034

  2. Gilligan C, Sanson-Fisher R, Eades S, D’Este C, Kay-Lambkin F, Scheman S. Identifying pregnant women at risk of poor birth outcomes. J Obstet Gynaecol (Lahore). 2009;29(3):181-187. doi:10.1080/01443610902753713

  3. Schiff MA, Grossman DC. Adverse Perinatal Outcomes and Risk for Postpartum Suicide Attempt in Washington State, 1987–2001. Pediatrics. 2006;118(3):e669 LP-e675. doi:10.1542/peds.2006-0116

  4. Bohren MA, Hofmeyr GJ, Sakala C, Fukuzawa RK, Cuthbert A. Continuous support for women during childbirth. Cochrane Database Syst Rev. 2017;(7). doi:10.1002/14651858.CD003766.pub6

  5. National Center for Immunization and Viral Disease. Considerations for inpatient obstetric healthcare settings. https://www.cdc.gov/coronavirus/2019-ncov/hcp/inpatient-obstetric-healthcare-guidance.html#anchor_1582067966715.

  6. American College of Obstetricians and Gynecologists. COVID-19 FAQs for Obstetrician-Gynecologists, Obstetrics. https://www.acog.org/clinical-information/physician-faqs/covid-19-faqs-for-ob-gyns-obstetrics.

  7. Scott KA, Britton L, McLemore MR. The Ethics of Perinatal Care for Black Women: Dismantling the Structural Racism in “Mother Blame” Narratives. J Perinat Neonatal Nurs. 2019;33(2). https://journals.lww.com/jpnnjournal/Fulltext/2019/04000/The_Ethics_of_Perinatal_Care_for_Black_Women_.5.aspx.

  8. Yancy CW. COVID-19 and African Americans. JAMA. April 2020. doi:10.1001/jama.2020.6548

  9. Flanders-Stepans MB. Alarming racial differences in maternal mortality. J Perinat Educ. 2000;9(2):50-51. doi:10.1624/105812400X87653

  10. Lind A, Richter S, Craft C, Shapiro AC. Implementation of Routine Postpartum Depression Screening and Care Initiation Across a Multispecialty Health Care Organization: An 18-Month Retrospective Analysis. Matern Child Health J. 2017;21(6):1234-1239. doi:10.1007/s10995-017-2264-5

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